Open Heart Surgery of the Future

Reported by ABC news’ Gitika Ahuja, from TEDMED2011, a conference on ideas and innovation.

More than half a million people in the U.S. undergo heart surgery every year. It has become a common and mostly successful surgery, but whenever I hear how it’s actually done, it shocks me. During open heart procedure, surgeons open the chest wall to get to your heart, cutting through the upper part of a patient’s breastbone to get there. Ouch.

For the past 75 years these surgeons — many now do more than one surgery a day — have been using an ancient-looking hand crank that winds open the chest, bit by bit. I tried the old hand crank in the Innovations Lounge here at TEDMED 2011.

Maybe the one I tried wasn’t well-oiled, but I can tell you that without having a breastbone to open up, the crank took some serious muscle power. In a real situation, when the chest opens, it can sound like lettuce tearing or sticks snapping. Chuck Pell, the chief scientist at Physcient, a new surgical device company based in Research Triangle Park, N.C., explained to me that not only is the hand crank technology just plain old (imagine that in the same time span of 66 years we went from flying airplanes to landing on the moon), cranking can really damage the tissue in the chest wall. You can break the sternum or ribs, damage cartilage or cause long term back pain.

So that’s the problem Pell’s company is trying to solve. Physcient has created a motorized retractor, i.e., a robot, to open the chest wall that a surgeon operates from a hand-held battery-powered controller. The device creates a smooth movement so that it is a lot less damaging to the chest tissue. Pell describes it as “anti-lock brakes” for chest retraction.

As the chest opens, the smart device senses when the tissue is tearing and stops until the tissue settles. The prototype is currently on an iPhone interface and seems very simple to use (meaning it won’t require surgeons hours of training like many other robotic- surgery-assist tools), but that’s not the way the product will be presented in operating rooms (Pell tells me that Apple actually discourages the medical community from using the iPhone during surgery because it doesn’t believe the phone is precise enough for something so important).

As for the cost, Pell said it would run a hospital about $500 per use, but he anticipates a huge cost savings by not having to treat other problems that arise from potential tissue damage in the long-term. The device still has a way to go — it has only been tested on pigs. Sheep are next and then, finally, humans. It will be about 18 months before the robot is submitted to the Food and Drug Administration for approval, but keep your ears — and heart — open for more in the future.

By the way, I asked Pell why this old technology hadn’t been updated until now. Surely, it has improved since the invention of the hand crank. And there is money to be made here. Pell told me that chest cranking is often done by a surgical resident, so this important procedure often didn’t even cross the surgeons’ plate.